Basic Information
| Provider Information | |||||||||
| NPI: | 1043511298 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COULES | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | P.A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2499 FARMERS AVE | ||||||||
| Address2: | |||||||||
| City: | BELLMORE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117103814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5168095415 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 222 ROCKAWAY TPKE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | CEDARHURST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115161833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5162391800 | ||||||||
| FaxNumber: | 5162395553 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2010 | ||||||||
| LastUpdateDate: | 11/04/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 004339 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.